A patient with a dying leg won't drive 20 miles for care. In Devin Zarkowsky's town, that's not a hypothetical. Vascular surgeon Devin Zarkowsky runs a solo office-based practice in a San Diego County town where peripheral arterial disease patients had nowhere local to go, and Jason McKittrick is the executive director of the Office-Based Facility Association. They discuss the KevinMD article "Why local care matters for peripheral arterial disease." You will hear how the Medicare physician fee schedule pays hospitals for big-ticket equipment but pays solo doctors out of the same bundled rate they use to cover staff and wire and drapes, why a four-figure atherectomy or Shockwave catheter swallows a week of revenue when there is no separate reimbursement, and why Congress is finally looking at fixing it after years of small fixes that did not close the gap. You will hear what local care actually means when a patient cannot drive and the limb cannot wait.

Learn which doctors treat hemorrhoids, including primary care physicians, gastroenterologists, colorectal surgeons, and specialists offering hemorrhoid embolization.

Learn how office workers can improve vascular health with simple daily habits to boost circulation, prevent vein issues, and stay healthy at work.

Learn the signs, causes, and treatment options for chronic venous insufficiency (CVI) and how expert care can relieve leg pain and swelling.

Hemorrhoids are extremely common, yet many people don’t realize that everyday habits play a major role in both their development and recurrence. While not all hemorrhoids can be prevented, certain lifestyle adjustments can significantly reduce your risk and help minimize uncomfortable flare-ups. Understanding these preventative strategies is especially important for patients who experience recurring symptoms. Why Hemorrhoids Develop Hemorrhoids form when pressure increases in the veins of the lower rectum. Over time, this pressure can cause veins to swell, stretch, and become irritated. Several factors contribute to this process, including: Straining during bowel movements Chronic constipation Prolonged sitting Low-fiber diets Pregnancy Aging-related vein changes Although hemorrhoids are a vascular condition, many triggers are manageable. Increase Fiber Intake One of the most effective ways to prevent hemorrhoids is to improve stool consistency. Fiber helps soften stool and promotes regular bowel movements, reducing the need for straining. Helpful sources of dietary fiber include: Fruits and vegetables Whole grains Legumes Fiber supplements when needed A gradual increase is recommended to avoid digestive discomfort. Stay Properly Hydrated Fiber works best when combined with adequate fluid intake. Dehydration can contribute to harder stools, increasing pressure on rectal veins. Consistent hydration helps: Maintain softer stool Improve digestive efficiency Reduce constipation risk Avoid Straining During Bowel Movements Straining is one of the most significant contributors to hemorrhoid formation. Excessive pressure directly stresses the rectal veins. Healthier habits include: Responding promptly to the urge to go Avoiding prolonged sitting on the toilet Allowing bowel movements to occur naturally Limit Prolonged Sitting Extended sitting — particularly on hard surfaces — increases pressure in the rectal region. This is especially relevant for individuals with sedentary occupations. Helpful strategies: Take standing or walking breaks Adjust seating ergonomics Reduce unnecessary toilet time Maintain Healthy Bowel Habits Irregular bowel patterns often increase hemorrhoid risk. Supporting digestive regularity reduces vascular strain. Supportive practices include: Consistent meal schedules Physical activity Fiber-rich nutrition Reduce Flare-Up Triggers For patients prone to recurrent hemorrhoids, symptom triggers may include: Heavy lifting Chronic coughing Constipation cycles Pregnancy-related pressure Identifying and managing triggers can help prevent symptom escalation. When Prevention Isn’t Enough While lifestyle modifications are highly effective for many patients, they do not eliminate existing hemorrhoids or advanced vascular changes. Medical evaluation may be appropriate if you experience: Persistent bleeding Ongoing discomfort Recurring flare-ups Painful swelling Hemorrhoids that do not respond to conservative care often benefit from minimally invasive treatments. A Preventative Approach to Long-Term Relief Hemorrhoid prevention is largely about reducing pressure and supporting healthy circulation. Small daily adjustments can produce meaningful improvements, particularly for patients with early or mild symptoms. For individuals with chronic or worsening hemorrhoids, specialized care can address the underlying vascular cause and provide lasting relief.

Learn the signs, causes, and treatment options for Peripheral Artery Disease (PAD). Early diagnosis helps prevent serious vascular complications.

Explore minimally invasive vascular treatments at California Vascular Health. Learn procedures, benefits, and what to expect for safer, effective care.

Explore how diet and exercise can directly effect vascular health, including best exercises, foods to avoid, and lifestyle tips for long-term vascular health.